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General NPI Number Information
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NPI Number | 1043083413
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Entity Type | Organization
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Legal Business Name | OPTIMISTIC WELLNESS LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 5119 NW KENDALL CT
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City | TOPEKA
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State | KS
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Zip | 66618-1269
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Country | US
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Telephone | 785-817-1893
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Fax | 785-587-0009
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Provider Business Mailing Address
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Address Line | 5119 NW KENDALL CT
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City | TOPEKA
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State | KS
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Zip | 66618-1269
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Country | US
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Telephone | 785-817-1893
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Fax | 785-578-0009
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Authorized Official
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Title or Position | CONSULTANT
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Name | DR. SHELDON B HAYNES
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Credential | M.D.
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Telephone | 785-817-1893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 247000000X
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Taxonomy Name | Health Information Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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